浆细胞性乳腺炎的临床特点分析

发布时间：2018-03-06 07:31

  本文选题：浆细胞性乳腺炎　切入点：导管扩张症　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景浆细胞性乳腺炎(plasma cell mastitis,PCM)是一种既可发生于非哺乳期又可发生于哺乳期的乳腺炎症,常见于中青年女性。根据疾病不同阶段的表现,也被称为导管扩张症(mammary duct ectasia,MDE)和导管周围乳腺炎(periductal mastitis,PDM)。近年来,发病率有上升倾向,但PCM长期以来没有规范的指南或共识,国内治疗很不规范,常与其他非哺乳期乳腺炎混为一谈,造成PCM常迁延不愈,逐渐破坏患者乳房,严重损害患者的身心健康。目的本研究通过收集郑州大学第三附属医院2015年1月至2016年12月的PCM住院治疗患者,统计分析一般资料、临床表现、实验室检查,了解PCM的部分临床特点,为PCM的规范诊治提供借鉴。资料与方法筛选从2015年1月至2016年12月在郑州大学第三附属医院入院治疗的浆细胞性乳腺炎患者72例作为实验组。另筛选同时期于郑州大学第三附属医院乳腺二科就诊的非PCM患者60例作为对照组。收集并描述资料,包括年龄、体重指数、哺乳史、哺乳障碍史、首次发病部位、临床分期、乳头内陷、雌二醇、孕酮、催乳素,并对体重指数、哺乳史、哺乳障碍史、乳头内陷、雌二醇、孕酮、催乳素进行组间比较。使用SPSS 21.0对资料进行统计描述和分析,使用SPSS 21.0、WPS 2016、Graph Pad Prism 5作图。结果1年龄72例PCM患者中,年龄的取值范围为18~56(岁),平均年龄为35.65±7.735(岁)。四分位间距为(30.25,40.75)岁。2体重指数72例PCM患者中,BMI24kg/m2的有36例,24kg/m2≤BMI≤28kg/m2的有30例,BMI≥28kg/m2的有6例。BMI的平均值为24.39±4.52。3哺乳72例PCM患者中,69例(95.8%)有生育史。有哺乳史的为49例(68.1%),其中19例(26.4%)有哺乳障碍史,无哺乳史的为20例。4临床表现72例PCM患者中,有66例为单侧发病,另外6例为双侧发病。首发部位在乳头乳晕区的为41例,占56.9%,首发在内上象限的为7例,占9.7%,首发在内下象限的为6例,占8.3%,首发在外下象限的为9例,占12.5%,首发在外上象限的为10例,占13.9%。72例的PCM患者中,溢液期有4例,肿块期为14例,脓肿期为22例,窦道为32例。溢液期患者比例为5.56%,肿块期患者比例为19.44%,脓肿期患者的比例为30.56%,窦道期患者的比例为44.44%。72例的PCM患者中,就诊时伴有患侧乳头内陷的患者为55例(73.4%),43例(59.7%)为先天性乳头内陷,12例(16.7%)为PCM导致的乳头内陷。5实验室检查统计72例的PCM患者雌二醇、孕酮、催乳素,雌二醇平均值为186.06±70.28ng/L,孕酮平均值为9.86±5.12ug/L,催乳素平均值为32.50±14.07ug/L。6组间比较BMI:实验组和对照组有显著差异(t’=3.275,df=129.648,P=0.001)。哺乳史:实验组与对照组差异无统计学意义(χ2=0.002,df=1,P=0.963)。哺乳障碍史:实验组与对照组的哺乳障碍史有显著性差异(χ2=9.830,df=1,P=0.002)。先天性乳头内陷:实验组与对照组的差异有统计学意义(χ2=46.314,df=1,P=0.000),PCM患者具有更高的先天性乳头内陷发病率。性激素:PCM组的雌二醇水平高于对照组(t’=6.608,df=121.143,P=0.000);实验组和对照组的孕酮水平没有显著差异(t=0.376,df=130,P=0.707);实验组的催乳素水平高于对照组(t’=7.238,df=121.259,P=0.000)。结论1.超重或肥胖、哺乳障碍史、先天性乳头内陷、高水平的雌二醇和催乳素是PCM相对于其他乳腺疾病的临床特点。2.由于PCM患者的雌二醇和催乳素水平较高,可试用抑制雌激素的内分泌治疗。
[Abstract]:The background of plasma cell mastitis (plasma cell, mastitis, PCM) is a kind of breast inflammation can occur in non lactating and can occur in lactation, common in young women. According to the different stages of the disease, also known as ductal ectasia (mammary duct, ectasia, MDE) and periductal mastitis (periductal mastitis, PDM). In recent years, the incidence rate is rising trend, but the PCM has not standardized guidelines or consensus, the domestic treatment is not standardized, and other non lactation mastitis caused by PCM is often confused, defer does not heal, gradually damage patients with breast, serious damage to physical and mental health of patients with treatment of patients. In the purpose of this study is through the collection of the Third Affiliated Hospital of Zhengzhou University from January 2015 to December 2016 PCM, statistical analysis of general data, clinical manifestation, laboratory examination, understanding PCM part of the clinical characteristics, diagnosis and treatment of PCM for the specification provided For reference. Materials and methods from January 2015 to December 2016, screening at the Third Affiliated Hospital of Zhengzhou University hospital treatment of patients with plasma cell mastitis in 72 cases as experimental group. The other phase of breast screening at the same time the Third Affiliated Hospital of Zhengzhou University two hospital 60 cases of non PCM patients as the control group. The collection and description of data, including age, body mass index. The history of lactation, lactation disorders, onset site, clinical stage, nipple, estradiol, progesterone, prolactin, and BMI, history of breastfeeding, breastfeeding disorders, nipple, estradiol, progesterone, prolactin were compared between the two groups. By using the data of SPSS 21 on the statistical description and analysis, the use of SPSS 21, WPS 2016, Graph Pad Prism 5 mapping. Results 1 cases of PCM patients in the age of 72, the range of age was 18~56 (year), the average age was 35.65 + 7.735 (four years old). The spacing for (30.25,40.75).2 body 閲嶆寚鏁，

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